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Abusive Nursing Home Employees: Lots of Blame to Go Around

February 26, 2009
by JRosenfeld
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Have you heard about the nursing home employees charged with the intentional drugging of residents at Kern Valley Nursing Home, in California? That’s right—three nursing home employees including the director of nursing, the pharmacist, and staff physician are all facing criminal charges related to the inappropriate use of sedatives and psychotropic medications to control the behavior of residents they were responsible for caring for.

A nursing home ombudsman first reported the situation to authorities when she witnessed the staff at Kern Valley forcibly restraining a resident as sedatives were injected against the person’s will. The ombudsman documented how nursing home staff administered narcotics without a physician’s order or supervision.

Use of chemical-restraints in nursing homes is not only dehumanizing but also against the law. The OBRA (Omnibus Budget Reconciliation Act of 1987), which provides Federal regulation of the nursing home industry specifically, states that: (1) residents are to be free from unnecessary drugs of all types, and (2) free from chemical restraints commonly thought of as psychotropic drugs, including antipsychotics, antidepressants, and hypnotic medications.

In this situation, the druggings resulted in severe physical deterioration of many residents because they were unable to eat and drink in their diminished capacity. An investigation into the matter by the California Attorney General concluded the deaths of three residents were directly related to the inappropriate use of medication.

While the alleged criminal behavior of the nursing home employees definitely deserves attention, perhaps the most startling part of this news story revolves around the Director of Nursing at Kern Valley. During her tenure at Kern Valley, the nursing director, Gwen Hughes, was allegedly able to employ an abusive agenda of forcibly medicating elderly nursing home residents who were deemed ‘disruptive’ by her. Hughes apparently instructed the entire staff at Kern Valley on what residents should be medicated and with what drugs. No one on the entire staff voiced any opposition to the unnecessary and harmful orders.

Prior to working at Kern Valley, Hughes worked at another California nursing home where she was fired for behavior similar to that which she stands accused of. After a state investigation, it was confirmed Hughes acted inappropriately when dispensing high dosages of psychotropic medication to residents. “We were so cowed and threatened with losing our jobs and our licenses that after a while we just shut our mouths and did what we had to do,” according to Trish Orr, a registered nurse for 25 years who worked with Hughes.

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I believe it is permissible to use psychotropic medications with a valid diagnosis and behaviors. While I would never force ANY medication on any resident, the use of psychotropics is often beneficial. Until we open specific units with specially trained staff for geriatric psych patients we will need to use these medications judiciously.

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